Abstract
An 8-year-old boy had undergone permanent epicardial pacemaker implantation with a Y-shaped bipolar ventricular lead on day 6 after birth for treatment of congenital complete atrioventricular block. He was found to have pulmonary stenosis and mitral stenosis by follow-up echocardiography. Further studies including computed tomography and cardiac catheterization revealed that the pacemaker lead had completely encircled the cardiac silhouette and was in a state of “cardiac strangulation”. We removed the previous pacing leads and generator and implanted a new epicardial dual-chamber pacing system in the right atrium and right ventricle. Additionally, an expanded polytetrafluoroethylene sheet was placed between the new leads and the heart to prevent recurrence of cardiac strangulation.
Highlights
Cardiac strangulation is a mechanical complication that occurs when epicardial pacemaker leads tighten around the heart
At 8 years of age, he was admitted to our hospital for catheter treatment of tiny patent ductus arteriosus. He had a systolic ejection murmur with no clinical symptoms. His lateral chest radiograph (Fig. 1) revealed that the pacemaker lead was completely wrapped around the cardiac silhouette, and we became concerned about cardiac strangulation
Opportunity of catheter treatment of tiny patent ductus arteriosus led us to the diagnosis of cardiac strangulation, and any fatal complication such as myocardial ischemia did not occur until surgical revision of the epicardial leads at 8-year-old
Summary
Cardiac strangulation is a mechanical complication that occurs when epicardial pacemaker leads tighten around the heart. We describe an 8-year-old boy who had undergone implantation of an epicardial ventricular pacing lead as a neonate for congenital complete atrioventricular block and later presented with suspected cardiac strangulation on echocardiography. The systolic pressure gradient at the main pulmonary artery (MPA) and mitral valve was Cardiac strangulation is a rare and life-threatening complication of epicardial pacemaker leads, and only a few cases have been reported [1–8] (Table 1). To prevent cardiac strangulation in neonates or even infants undergoing implantation of an epicardial pacemaker, redundant leads must not be looped very long anteriorly around the cardiac chambers nor placed inside the pericardium. In the other hospital at his 11 months of age, the lateral view
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